When teenage pregnancy is a death sentence

Each year, more than 350,000 young women die after falling pregnant – one every two minutes. Now, a new international drive is under way to deliver contraception to poverty-stricken nations, and so slash mortality rates
  • @S_R_Morrison

Joventa Kyasiimire is defiant. As we stand with hundreds of young women queuing in Uganda's midday sun outside Kanungu health centre, she is telling me how she fell pregnant unexpectedly in September 2010 aged 17, how her boyfriend fled a week after he found out she was expecting and how, just days later, she learnt she was HIV positive. Ostracised by many in her community, Kyasiimire left school to look after her son, Godias, now 11 months, giving up her dreams of becoming a teacher.

Now selling home-grown vegetables in an attempt to provide for Godias, Kyasiimire doesn't sound like she has much to be grateful for, except that Godias, mercifully, is not HIV positive. Yet many teenage girls in her circumstances fare worse: unintended pregnancy is the biggest killer of teenage girls in the developing world. Young women aged 15 to 19 are twice as likely to die from complications in pregnancy as are women in their twenties. For mothers under 18, their babies' chance of dying in the first year of life is 60 per cent greater than that of a baby born to someone aged 19 or older.

The fact that Kyasiimire and so many other women are in this snaking queue is a sign of hope. Soon she will be injected with a contraceptive implant, inserted under the skin of her upper arm, that will protect her from the risk of another unwanted pregnancy for the next three years.

Though it took Kyasiimire a couple of hours to walk to this rural clinic from her home in south-west Uganda, she is no longer one of the 215 million women around the world – with no means of accessing contraception – who want to avoid pregnancy, or at least want to choose when they have their children. These women account for 82 per cent of the 75 million unintended pregnancies that occur globally every year. Access to family planning services could reduce the number of maternal deaths by a third.

The need for money – and awareness campaigns – to help these women is so critical that the British government and the Bill and Melinda Gates Foundation are holding a summit on family planning in London next month. They aim to provide 120 million of the world's poorest women with access to contraception over the next eight years, at an estimated cost of almost £2.6bn.

A report to be launched in Parliament on Tuesday by Andrew Mitchell, the International Development Secretary, will reveal that though in the developed world 60 to 80 per cent of women have access to contraception, in sub-Saharan Africa the figure is below 20 per cent. On current trends, south Asia will not reach 60 per cent for 20 years, east Africa for 45 years and central and western African for a startling 500 years, according to the reproductive health charity Marie Stopes International.

Like so many of the women around us, Kyasiimire says she was too young to have a child when she did. She looks at her son, now balanced on her hip, and adds quietly: "If I had known about contraceptives before, I would have taken them."

Unlike in the West, pregnancy is not primarily a matter of lifestyle. Here, it is a life and death issue. Dana Hovig, chief executive of Marie Stopes International, said: "Every year 358,000 women die due to pregnancy or childbirth – that's one woman every two minutes. Many of those women did not plan to be pregnant. Equally tragic is that 47,000 women die every year because of unsafe abortions."

The issue of contraception has long been a political hot potato, especially in the United States. In 2002, the Bush administration withdrew US money for the United Nations Population Fund, claiming it financed forced abortions. The Obama administration has since restored the funding; it is estimated that an additional 90,000 lives could still be saved every year if there was more family planning provided.

Babatunde Osotimehin, executive director of the UN fund, said that teenage pregnancy was the "big issue" to be addressed at next month's summit: "In most African countries, 60-70 per cent of the population are under the age of 30. Family planning is the most important human development intervention there is: it enables young people to make choices about their lives; it ensures women can have the number of children they want and can look after; and it gives them the possibility to protect themselves from infectious diseases."

The statistics, translated into the real world, are devastating. Kyasiimire lives in a district where half of the teenagers have children, in a country where a quarter of all teenage girls are mothers. While government policy states adolescents should have access to comprehensive family planning, there is a stigma to supplying contraceptives to teens, getting them into the clinics and dispelling the myths that surround the services.

Around 10 per cent of births in Uganda involve girls under 15, according to Reproductive Health Uganda, which notes that the east African country's population growth rate – at 3.3 per cent each year – is one of the highest in the world.

The UK – until very recently the teenage pregnancy capital of Europe – now has the lowest under-18 conception rate since 1969, down to 35.5 conceptions per thousand women aged 15 to 17.

As we enter Kanungu health centre, the waiting rooms are filled with young mothers. Kate Tumuhimbes, 26, first fell pregnant at 14 and now has three children, with one more on the way. Her first delivery was so painful she had to give birth on her hands and knees.

Beatrice Niwabine, 19, fell pregnant for the first time at 16 and is now expecting her second child. Unable to provide for her son, Owen, she says quietly that she wished she had waited until she was older to give birth.

But Kyasiimire is hopeful. She is one of 37,000 people in Uganda who the UN-funded family planning clinics have reached since 2010. The Ugandan government will soon announce that for the first time in years, the country's fertility rate has fallen – from 6.7 babies per woman to 6.2 – and modern contraceptive use has increased from 18 to 26 per cent. "Life is starting to normalise," she tells me, before she leaves. "Finally, I have control over my decisions."